Basic Information
| Provider Information | |||||||||
| NPI: | 1548768575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEDRICH | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | JUSTINE | ||||||||
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| Credential: | BS, RBAI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1432 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977091432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413063483 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19800 VILLAGE OFFICE CT STE 104 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977021813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413063483 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2018 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106S00000X | Y |
No ID Information.